Provider Demographics
NPI:1174991491
Name:MEIERDIERCKS, JENNA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:MEIERDIERCKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2606
Mailing Address - Country:US
Mailing Address - Phone:301-681-7101
Mailing Address - Fax:855-885-1472
Practice Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 460
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3565
Practice Address - Country:US
Practice Address - Phone:301-977-4100
Practice Address - Fax:855-885-1472
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR253352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily